Asthma in Women, Asthma in Pregnancy (cont.)

Following these recommendations down the last detail would be unrealistic, of course, but at least they are guidelines. Additionally, perhaps some of the chores that are associated with asthma triggers can be done when the person with asthma is out of the house.

Although these recommendations have not been proven to be totally effective (indeed some research finds these measures to not be helpful at all), they are inexpensive and without side effects compared to medications, and therefore are considered standard measures for consideration by every asthma. Physicians generally counsel all asthmatic patients regarding these measures, if they are found to be allergic by skin or blood testing.

Do Filters Help?

High-energy particulate absorption (HEPA) filters have recently gained in popularity. They are filters that remove many allergens from the air. There is not complete proof that these filters should be used by everyone with asthma.

Treatment With Medication: General Considerations

Key point: The risk of asthma that is not controlled in pregnancy is greater than the risk of using medication! The baby needs oxygen!

There are several kinds of asthma medications. Generally, they come in two categories: fast-acting medication (called rescue medication, used for immediate relief of symptoms) and medication (maintenance therapy) that is used regularly each day to prevent the need for the rescue medication. Preventive asthma medications are not addictive, even when used for years!

People who really know how to use their asthma medications and how to alter them with changes in their asthma symptoms not only feel better about their asthma, but research is also beginning to prove that they also have more healthy days than people who just visit the doctor at regular intervals.

Allergy shots (Immunotherapy) is effective for most people with hayfever. It clearly also helps some people with asthma as well. Those asthmatics likely to respond are children, highly allergic individuals and those with poorly controlled hayfever or sinusitis.

The latest treatment recommendations are based on the National Asthma Education and Prevention Program's Report of the Second Expert Panel on the Guidelines for the Diagnosis and Management of Asthma, published in 1997 (2). These treatment guidelines, sponsored by the National Heart, Lung, and Blood Institute, give more emphasis to the use of anti-inflammatory medications, and to possible prevention of asthma, than did prior guidelines. The plan is called a "step approach". This means that if one medication does not do the job, the dose or frequency of doses is raised and other medication is added, and then as the asthma is better controlled, the medications are decreased in a "step down". The 2 generally categories of medication are controller medications (maintenance medications) and reliever medications (rescue medications).

A. Rescue Medication: Inhaled for Quick Relief

For acute, meaning immediate, relief, medication that dilates (opens) the airways is used. These medications, b-agonists, are usually taken in inhaled forms, called metered dose inhalers (MDI's). Examples include albuterol and metaproterenol. There are few side effects of these inhaled bronchodilator medications. Some people may get palpitations, a sense of the heart beating fast, or a sense of feeling "jittery". Some people seem to be more sensitive to those side effects than others. Some people may notice this type of side effect only occur at high doses of the medications. This quick relief medicine should always be carried in case of unexpected need. Often people will be told to keep these medications scattered in easy-to-find locations, like purses or pockets, desk at work, or glove compartment.

B. Maintenance Therapy: Inhaled for Long-Term Control

Because asthma's underlying cause is thought to be inflammation (swelling in the airways), anti-inflammatory therapy is the basis for prevention of acute attacks (exacerbations). Daily preventive (maintenance) medication may be needed if people cough, wheeze, or have chest tightness more than once weekly, if night-time asthma wakes them up, if they have many asthma attacks, or if they are using asthma rescue medication daily.

Therapy consists of inhaled corticosteroids. Corticosteroids are drugs that if taken orally can have significant side effects over the long-term, although these are not the same drugs that became popular with body-builders. Therefore, inhaled forms of the corticosteroids were developed in the form of MDI's. Examples include fluticasone, beclomethasone, and budesonide. Although it is known which of these is the most potent compared to the others (fluticasone), studies actually comparing use of the medications are not very numerous. Steroids are anti-inflammatory, so that they decrease airway swelling, lessen mucus, and decrease the overly active "twitchy" problem in the airways.

There are no immediate side effects of steroid MDI's that a person would feel. Thrush, a whitish yeast infection on the tongue, can occur as a side effect, and is minimized by rinsing out the mouth with water after use and using a "spacer" device that attaches to the inhaler. Spacers are available by prescription and help the medication get into the lungs instead of depositing in the mouth. Based on the fact that use of oral steroids can put people at risk of osteoporosis (brittle bones), there is some concern that inhaled steroids might also decrease bone density, and as a consequence cause fractures later on. The research so far is regarding this possible side effect is controversial, but suggests that this possible side effect is greater with higher potency or higher doses of inhaled steroids. Hopefully the exact degree of risk with different preparations and doses will become clearer in the future. For the time being, consulting with a physician that adequate calcium intake, vitamin D intake, and exercise are being achieved for bone health is a wise idea.